A/HRC/14/39 important elements in ensuring the right to health.78 The Special Rapporteur on the right to health has defined accountability as “ensuring that health systems are improving, and the right to the highest attainable standard of health is being progressively realized, for all, including disadvantaged individuals, communities, and population”.79 36. Regular monitoring of the health system and the underlying physical and socioeconomic determinants of health that affect women’s health and ability to exercise their rights is a critical component of accountability. Without monitoring, systemic failures in reducing maternal mortality and morbidity cannot be corrected. When States adopt and implement a national public health strategy and plan of action,80 they should also develop “appropriate indicators to monitor progress made, and to highlight where policy adjustments may be needed”.81 Monitoring helps States parties develop a better understanding of the “problems and shortcomings encountered” in realizing rights, providing them with the “framework within which more appropriate policies can be devised”.82 Data based on appropriate indicators should be disaggregated on the basis of the prohibited grounds of discrimination to monitor the elimination of discrimination83 as well as to ensure that vulnerable communities are benefiting from health-care schemes. 37. As an accountability measure designed to reduce maternal mortality, the Special Rapporteur on the right to health has strongly recommended that all States introduce, as a matter of urgency, a comprehensive, effective registration system, as well as a system of maternal death audits, in order to find out why the deaths occurred. Such maternal death audits, the Special Rapporteur notes, should be a non-judicial review that goes beyond medical reasons to identify the social, economic and cultural reasons that led or contributed to the death.84 38. The principle of accountability is closely linked to the right of victims to remedy including reparation.85 Effective access to remedies and reparation contributes to a constructive accountability framework by focusing on system failures and encouraging repair. The components of remedies and reparation were articulated through the Basic Principles and Guidelines on the Right to a Remedy and Reparation for Victims of Gross Violations of International Human Rights Law and Serious Violations of International Humanitarian Law approved by the General Assembly in 2005.86 2. Participation 39. Participation is an operational principle of a rights-based approach that has come to be recognized as a right in itself. At the International Conference on Primary Health Care in Almaty in 1978, 134 Governments and 67 international organizations agreed that “the people have the right and duty to participate individually and collectively in the planning and implementation of their health care”.87 Participation in the context of maternal mortality and morbidity means granting women access to relevant information and including them in the decision-making processes which affect their pregnancy and childbirth. The Special Rapporteur on the right to health has noted, in the context of reducing maternal mortality 78 79 80 81 82 83 84 85 86 87 GE.10-12949 CESCR, general comment No. 14, paras. 59–62. Report of the Special Rapporteur on the right to health (A/63/263), para. 12. CESCR, general comment No. 14, para. 43 (f). A/61/338, para. 28 (e). CESCR, general comment No. 1: Reporting by States parties (1989), para. 8. CESCR, general comment No. 20, para. 41. Report of the Special Rapporteur on the right to health (A/HRC/7/11/Add.4), para. 16. CESCR, general comment No. 14, para. 59. General Assembly resolution No. 60/147, annex. Declaration of Alma-Ata, para. IV. 15